Glycemic control in gestational diabetes mellitus-How tight is tight enough: Small for gestational age versus large for gestational age?

Oded Langer, Judith Levy, Lois Brustman, Akolisa Anyaegbunam, Ruth Merkatz, Michael Divon

Research output: Contribution to journalArticle

283 Scopus citations


The relationship between optimal levels of glycemic control and perinatal outcome was assessed in a prospective study of 334 gestational diabetic women and 334 subjects matched for control of obesity, race, and parity. All women with gestational diabetes mellitus were instructed in the use of a memory-based reflectance meter. They were treated with the same metabolic goal according to a predetermined protocol. Three groups were identified on the basis of mean blood glucose level throughout pregnancy (low, ≤86 mg/dl; mid, 87 to 104 mg/dl; and high, ≥105 mg/dl). The low group had a significantly higher incidence of small-for-gestational-age infants (20%). In contrast, the incidence of large-for-gestational-age infants was 21-fold higher in the mean blood glucose category than in the low mean blood glucose category (24% vs. 1.4%, p < 0.0001). An overall incidence of 11% small-for-gestational-age and 12% large-for-gestational-age infants was calculated for the control group. A significantly higher incidence of small-for-gestational-age infants (20% vs. 11%, p < 0.001) was found between the control and the low category. In the high mean blood glucose category an approximate twofold increase was found in the incidence of large-for-gestational-age infants when compared with the control group (p < 0.03). No significant difference was found between the control and mean blood glucose categories (87 to 104 mg/dl). Our data suggest that a relationship exists between level of glycemic control and neonatal weight. This information is helpful in targeting the level of glycemic control while optimizing pregnancy outcome in gestational diabetes comparable to the general population.

Original languageEnglish (US)
Pages (from-to)646-653
Number of pages8
JournalAmerican Journal of Obstetrics and Gynecology
Issue number3
StatePublished - Sep 1989



  • Gestational diabetes
  • intrauterine growth retardation
  • level of control
  • macrosomia

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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